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Should Impacted Teeth Always Be Removed?

You have an impacted tooth, so it’s necessary to remove it immediately, right? Maybe not. Are you in pain? Is the tooth causing you problems? While it’s true that impacted teeth are potentially harmful, removal isn’t the only option. Removing impacted teeth depends on several factors, including which tooth is the problem, what symptoms are present and if the tooth is causing dental issues now or could cause them in the future.

Do You Have an Impacted Tooth? Look for the Symptoms

Pain is a symptom of impacted teeth, but some people don’t experience pain. In fact, some people have no symptoms at all with impacted teeth. How can you tell if a tooth is impacted when there are no symptoms? Through regular checkups, a dentist will spot the problem. If something occurs between visits, there are symptoms to watch for. They usually show up when the tooth becomes infected, or it starts to impact other teeth, such as pushing against the roots and moving them out of their normal position. Here are the symptoms, but keep in mind that some symptoms may also represent other dental issues, such as periodontal disease.

• You might have jaw pain or swelling.
• Your gums might be red, swollen or tender, and they may bleed.
• You might have trouble opening your mouth or experience an unpleasant taste in your mouth.
• You may have bad breath.

Here’s Why You Have Impacted Teeth

Normally, teeth pass through the gums and emerge above the gum line. This happens with baby teeth and again with permanent teeth. Sometimes, a tooth emerges partially or does not erupt at all, which means it is impacted. Our third set of molars, the wisdom teeth, are the last to come in and the most likely to become impacted. Cuspids and bicuspids have the potential for impaction also.

Why does this happen? Well, the biggest reason is probably overcrowding. Let’s say a person has all their teeth except wisdom, and there’s no more room in their mouth for other teeth. When the third set of molars begins to emerge, where will they go? These teeth will be trapped below the gums or force their way above, which can lead to crooked teeth and other issues. Another reason for impaction is tooth displacement, which happens when a tooth emerges at an odd angle and doesn’t fully emerge.

There are actually several methods of impaction. Vertical impaction is when teeth grow in straight, but the mouth is too small for all teeth to fit, and horizontal impaction occurs when impacted teeth lie on their side. Distal impacted teeth are angled toward the back side of the mouth, while a mesial impaction is when the angle of teeth is forced too far forward in the mouth. When a tooth emerges through the gums but is still partially within the jawbone, it is a bony impaction.

Removing Impacted Teeth

Should impacted teeth always be removed? The answer depends on your dentist. Some dental professionals recommend doing nothing if the impacted tooth is not causing problems. Overcrowding it a common reason for this dental issue, but some people with the problem actually have space in their mouth to accommodate more teeth. For them, the impacted tooth may never be an issue. Other dental professionals might recommend removing the tooth even if it is not problematic now because it could result in dental problems in the future.

When removing the tooth, here’s what happens. First, there is the initial dental exam, and you may have X-rays so the dentist can get the clearest indication of the problem. If the dentist can remove the tooth easily, it should be like a typical dental appointment, but many cases require the dentist to refer patients to an oral surgeon. For that appointment, there may be more imaging tests, and the surgeon will discuss sedation options and other aspects of the procedure. During extraction, the surgeon incises an area near the impacted tooth and removes the tooth. Sometimes the tooth can’t be removed as a whole tooth, so the surgeon will take it out in pieces. Advanced cases may require some bone or tissue removal. Afterward, the incision is stitched closed. After removal, patients usually have swelling, pain and bleeding. Patients are often prescribed pain medicine.

Don’t Want to Remove Those Impacted Teeth? Here’s What to Expect

Unless the issue is painful, some people choose to leave their impacted teeth in place. Misaligned teeth may result because of structural problems caused by the roots of teeth crashing into each other. If you’re unhappy with crooked teeth, expensive orthodontia treatments may be the only solution. Another problem with leaving impacted teeth in place is that there are multiple issues happening inside your mouth that you have no idea about. For instance, a partially impacted tooth that breaks through the gum line leaves an opening for bacteria to enter, and that leads to infection.

Another potential problem is that wisdom teeth develop inside a sac in the jawbone. That sac could fill with fluid and form cysts, and the cysts have the potential to damage not only your teeth and jawbone, but the nerves within them as well. On rare occasions, a non-cancerous tumor forms.

How about tooth decay? That’s very likely with partially impacted wisdom teeth. Because these molars are so far back in the mouth and more difficult to clean, food and bacteria get trapped there. Unfortunately, that problem can lead to pericoronitis, or gum disease. With that, expect painful, inflamed gums.

Making a Decision About Impacted Teeth

Having an impacted tooth can be painful or not, and it can cause problems or exist within your mouth totally unknown to you. Remember, not everyone has symptoms. One thing to keep in mind is that pain in the mouth could be related to another issue, such as a tooth infection, so keep an eye out for any other symptoms. If you suspect an impacted tooth, it’s a good idea to check with a dentist to decide whether it needs removal.

About Dr. Sandhu

Dr. Rimple Sandhu, both a dentist and dental school professor, is knowledgeable in surgical and nonsurgical periodontal treatments. This includes periodontal disease, bone grafting, sinus elevation and gingival recession, as well as impacted teeth extractions, implants and crown lengthening. Dr. Sandhu is a member of the American Dental Association, American Academy of Periodontology and the Delaware Valley Academy of Osseointegration. Please visit for more information.


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